A comprehensive view of knowledge and osteoporosis status among type 2 diabetes mellitus in Malaysia: A cross sectional study
Background: osteoporosis and diabetes mellitus are highly prevalent diseases that have potentially devastating effects on health and socioeconomic status.
Objective: The aims of this study were to assess: 1) the level of osteoporosis knowledge among T2DM patients; 2) the correlation, associations or differences of demographic characteristics, diabetes-related variable, as well as, lipid and blood pressure profiles with osteoporosis knowledge; and 3) the correlation between T-score measurement using quantitative ultrasound scan (QUS) and osteoporosis knowledge.
Methods: A cross-sectional study design was chosen, where data was collected using a self-report structured questionnaire using osteoporosis knowledge - Malay version questionnaire (OKT-M) among T2DM patients. Furthermore, the clinical data regarding the patients were collected retrospectively from the hospital medical record after patient interview was completed.
Results: The average age of the patients was 62.67 (SD 9.24) years (ranged from 33 to 87 years). Males (231, 51.30%) slightly outnumbered females. Among the racial distribution, the proportion of Chinese patients (204, 45.30%) was higher than Malay (127, 28.20%) and Indian patients (119, 26.40%). In addition, more than three quarters (343, 76.20%) of patients had poor glycaemic control. The average OKT-M total score, OKT-M Exercise subscale and OKT-M Calcium subscale were 12.55 (SD 4.06), 8.60 (SD 2.89) and 8.40 (SD 3.36), respectively. Only 33.30% of the T2DM patients were found to have high level of osteoporosis knowledge. There was a lack of identification and recognition of osteoporosis risk factors. There were significant differences or associations between osteoporosis knowledge and education level, monthly income, employment status, family history of fracture, smoking habit, alcoholic status, insulin use, therapy type and diastolic blood pressure. In addition, significant and positive correlations were found between T-scores and OKT-M total score (n=450, rs= 0.244, P=0.000), OKT-M Exercise subscale (n=450, rs= 0.219, P=0.000) and OKT-M Calcium subscale (n=450, rs=0.199, P=0.000) among T2DM patients (all Ps<0.05).
Conclusions: Overall, the study results showed a valuable insight into the knowledge toward osteoporosis, as well as its relation to the bone loss among T2DM patients. It is important to understand the basics of osteoporosis prevention behaviours such as adequate calcium intake and regular exercise which are essential to build and maintain healthy bones throughout life among T2DM.
Zimmet P, Alberti K, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414(6865):782-787. https://doi.org/10.1038/414782a
Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag S, Connolly V, King H. The burden of mortality attributable to diabetes. Diabetes Care. 2005;28(9):2130-2135. https://doi.org/10.2337/diacare.28.9.2130
Rashid AR. Suboptimal treatment in chronic diseases–time to go back to basics. Med J Malaysia. 2008;63(3):185-187.
Letchuman G, Wan Nazaimoon W, Wan Mohamad W, Chandran L, Tee G, Jamaiyah H, Isa M, Zanariah H, Fatanah I, Ahmad Faudzi Y. Prevalence of Diabetes in the Malaysian National Health Morbidity Survey III 2006. Med J Malaysia. 2010;65(3):180-186.
Mafauzy M. Diabetes mellitus in Malaysia. Med J Malaysia. 2006;61(4):397-398.
Kamarul Imran M, Ismail AA, Naing L, Wan Mohamad WB. Type 2 diabetes mellitus patients with poor glycaemic control have lower quality of life scores as measured by the Short Form-36. Singapore Med J. 2010;51(2):157-162.
Horan A, Timmins F. The role of community multidisciplinary teams in osteoporosis treatment and prevention. J Orthop Nurs. 2009;13(2):85-96. https://doi.org/10.1016/j.joon.2009.03.003
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22(3):465-475. https://doi.org/10.1359/jbmr.061113
Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV. Residual lifetime risk of fractures in women and men. J Bone Miner Res. 2007;22(6):781-788. https://doi.org/10.1359/jbmr.070315
Abdulameer SA, Syed Sulaiman SA, Hassali MA, Subramaniam K, Sahib MN. Osteoporosis and type 2 diabetes mellitus: what do we know, and what we can do? Patient Prefer Adherence. 2012;6:435-448. https://doi.org/10.2147/PPA.S32745
Tung WC. Osteoporosis among Asian American women. Home Health Care Manag Pract. 2012;24(4):205-207. https://doi.org/10.1177%2F1084822312441702
Abdulameer SA, Sahib MN, Sulaiman SAS. The Prevalence of Osteopenia and Osteoporosis Among Malaysian Type 2 Diabetic Patients Using Quantitative Ultrasound Densitometer. Open Rheumatol J. 2018;12:50-64. https://doi.org/10.2174/1874312901812010050
Edmonds E, Turner LW, Usdan SL. Osteoporosis knowledge, beliefs, and calcium intake of college students: Utilization of the health belief model. Open J Prev Med. 2012;2(1):27-34.
Abdulameer SA, Sahib MN. Cross-Cultural adaptation and psychometric properties of Osteoporosis Knowledge Tool-Arabic version among Iraqi population. Open Rheumatol J. 2019;13(1):30-38.
Zanariah H, Chandran LR, Wan Mohamad WB, Wan Nazaimoon WM, Letchuman GR, Jamaiyah H, Fatanah I, Nurain MN, Helen Tee GH, Mohd Rodi I. Prevalence of diabetes mellitus in Malaysia in 2006-results of the 3rd National Health and Morbidity Survey (NHMS III). Diabetes Res Clin Pract. 2008;79:21-29. https://doi.org/10.1016/S0168-8227(08)70699-5
Ministry of Health Malaysia. Clinical Practice Guidelines: Management of type 2 diabetes mellitus. Available from World Wide Web: http://www.moh.gov.my (accessed Jan 20, 2012).
Abdulameer SA, Syed Sulaiman SA, Hassali MA, Subramaniam K, Sahib MN. Psychometric Properties of Osteoporosis Knowledge Tool and Self-Management Behaviours Among Malaysian Type 2 Diabetic Patients. J Community Health. 2013;38(1):95-105. https://doi.org/10.1007/s10900-012-9586-4
Kanis J. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int. 1994;4(6):368-381. https://doi.org/10.1007/bf01622200
Osman AA. Assessment of Osteoporosis KAP among women in Assir region, Saudi Arabia. J Med Med Sci. 2013;4(2):50-55.
Ziccardi SL, Sedlak CA, Doheny MO. Knowledge and health beliefs of osteoporosis in college nursing students. Orthop Nurs. 2004;23(2):128-133. https://doi.org/10.1097/00006416-200403000-00010
Zhang RF, Chandran M. Knowledge of osteoporosis and its related risk factors among nursing professionals. Singapore Med J. 2011;52(3):158-162.
Moodley LM, Rambiritch V. An assessment of the level of knowledge of diabetic patients, in a primary health care setting, on diabetes mellitus. S Afr Fam Pract. 2007;49(10):6-16. https://doi.org/10.1080/20786204.2007.10873652
Von Hurst PR, Wham CA. Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women. Public Health Nutr. 2007;10(7):747-753. https://doi.org/10.1017/S1368980007441477
Orces CH, Casas C, Lee S, Garcia-Cavazos R, White W. Determinants of osteoporosis prevention in low-income Mexican-American women. South Med J. 2003;96(5):458-464. https://doi.org/10.1097/01.SMJ.0000051905.38128.B4
Cinda A, Sava S. What do men who are at risk of osteoporosis know about osteoporosis in developing countries? Scand J Caring Sci. 2004;18(2):188-192. https://doi.org/10.1111/j.1471-6712.2004.00268.x
Chang S, Yang R, Chung U, Chen C, Cheng M. Perception of risk factors and DXA T score among at risk females of osteoporosis. J Clin Nurs. 2010;19(13-14):1795-1802. https://doi.org/10.1111/j.1365-2702.2009.03063.x
Satterfield T, Johnson SM, Slovic P, Neil N, Schein JR. Perceived risks and reported behaviors associated with osteoporosis and its treatment. Women Health. 2000;31(4):21-40. https://doi.org/10.1300/j013v31n04_02
Matthews HL, Laya M, DeWitt DE. Rural women and osteoporosis: awareness and educational needs. J Rural Health. 2006;22(3):279-283. https://doi.org/10.1111/j.1748-0361.2006.00047.x
Asikainen T, Kukkonen-Harjula K, Miilunpalo S. Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials. Sports Med. 2004;34(11):753-778. https://doi.org/10.2165/00007256-200434110-00004
Pande K, Pande S, Tripathi S, Kanoi R, Thakur A, Patle S. Poor knowledge about osteoporosis in learned Indian women. J Assoc Physicians India. 2005;53:433-436.
Miura S, Yagi M, Saavedra OL, Yamamoto S. Sociodemographic Variation in Knowledge of Osteoporosis and Locally Available Calcium-Rich Foods Among Urban Women Living on Low Incomes in Davao, Philippines. Health Care Women Int. 2010;31(5):387-401. https://doi.org/10.1080/07399330903411150
Carlsson L, Johnson C. Osteoporosis Health Beliefs and Practices Among Korean Immigrants in Nova Scotia J Immigr Health. 2004;6(2):93-100. https://doi.org/10.1023/B:JOIH.0000019169.41271.f5
Johnson CS, McLeod W, Kennedy L, McLeod K. Osteoporosis health beliefs among younger and older men and women. Health Educ Behav. 2008;35(5):721-733. https://doi.org/10.1177/1090198107301331
Yeap SS, Goh EM, Das Gupta E. Knowledge about osteoporosis in a Malaysian population. Asia Pac J Public Health. 2010;22(2):233-241. https://doi.org/10.1177/1010539509343948
Rafraf M, Bazyun B, Afsharnia F. Osteoporosis-related life habits and knowledge about osteoporosis among women in Tabriz, Iran. Iran Med J. 2009;8(2):17-20.
Riaz M, Abid N, Patel J, Tariq M, Khan MS, Zuberi L. Knowledge about Osteoporosis among healthy women attending a tertiary care hospital. J Pak Med Assoc. 2008;58(4):190-194.
Zaini WM, Md Ariff A. Bone Mineral Density Assessment in Pre- and Postmenopausal Women: Comparison Between T-Scores by Heel QUS and DXA in HRPZII. Med J Malaysia. 2012;67(5):487-490.
Kim S, Symons M, Popkin BM. Contrasting socioeconomic profiles related to healthier lifestyles in China and the United States. Am J Epidemiol. 2004;159(2):184-191. https://doi.org/10.1093/aje/kwh006
Liza H, Darat HN, Pande KC. Knowledge about osteoporosis in Bruneian women attending an orthopaedic clinic. Malays Orthop J. 2009;3(1):28-31.
Shin H-Y, Kang HC, Lee K, Park SM. Association between the awareness of osteoporosis and the quality of care for bone health among Korean women with osteoporosis. BMC Musculoskelet Disord. 2014;15:334. https://doi.org/10.1186/1471-2474-15-334
Chen S-W, Yang S-C, Wang R-H, Lin ML. Osteoporosis prevention behaviors practiced among youth in Taichung City, Taiwan. Am J Health Behav. 2012;36(6):736-745. https://doi.org/10.5993/AJHB.36.6.2
Olmos JM, Hernandez JL, Martínez J, Castillo J, Valero C, Perez Pajares I, Nan D, Gonzalez-Macías J. Bone turnover markers and bone mineral density in hypertensive postmenopausal women on treatment. Maturitas. 2010;65(4):396-402. https://doi.org/10.1016/j.maturitas.2010.01.007
Broussard DL, Magnus JH. Influence of cardiovascular disease risk factors on the relationship between low bone mineral density and type 2 diabetes mellitus in a multiethnic US population of women and men: a cross-sectional study. Gend Med. 2008;5(3):229-238. https://doi.org/10.1016/j.genm.2008.07.006
Chang SF. Explore the effectors of bone mineral density in community women. J Nurs Res. 2004;12(4):327-336. https://doi.org/10.1097/01.jnr.0000387517.67490.2a
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. https://doi.org/10.1037//0033-295x.84.2.191
Abdulameer SA, Syed Sulaiman SA, Hassali MA, Subramaniam K, Sahib MN. Psychometric properties and osteoprotective behaviors among type 2 diabetic patients: osteoporosis self-efficacy scale Malay version (OSES-M). Osteoporos Int. 2013;24(3):929-940. https://doi.org/10.1007/s00198-012-2071-1
Abdulameer SA, Syed Sulaiman SA, Hassali MA, Sahib MN, Subramaniam K. Psychometric properties of the Malay version of the Osteoporosis Health Belief Scale (OHBS‐M) among Type 2 diabetic patients. Int J Rheum Dis. 2014;17(1):93-105. https://doi.org/10.1111/1756-185X.12104
Sahib MN. Validation and Assessment of Osteoporosis Self-Efficacy Among Iraqi General Population. Open Nurs J. 2018;12:76-85. https://doi.org/10.2174/1874434601812010076
Sahib MN. Psychometric properties and assessment of the Osteoporosis Health Belief Scale among the general Arabic population. Patient Prefer Adherence. 2018;12:223-232. https://doi.org/10.2147/PPA.S155152
Doheny MO, Sedlak CA, Estok PJ, Zeller RA. Bone density, health beliefs, and osteoporosis preventing behaviors in men. Orthop Nurs. 2011;30(4):266-272. https://doi.org/10.1097/NOR.0b013e3182247a84
The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.